p489 handbook 2015 final updatedmay · 2016. 12. 7. · phar(489(handbook(4 copyright © 2012 ubc...

Phar489 Handbook Copyright © 2012 UBC Faculty of Pharmaceutical Sciences

OFFICE OF EXPERIENTIAL EDUCATION APPE – Institutional

PHAR 489 (Effective MAY 2015)

Course Coordinators:

Dr. Michael Legal & Ms. Aileen Mira


Table of Contents

ACKNOWLEDGEMENT .................................................................................................................................... 4

INTRODUCTION ............................................................................................................................................... 5

GLOBAL OBJECTIVES ....................................................................................................................................... 6

ASSESSMENT MEASURES .............................................................................................................................. 7

PHARMACY 489 ............................................................................................................................................. 9

PHARMACY 489 CLERKSHIP ACTIVITIES ................................................................................................... 11

SUGGESTED GUIDE TO KEEP ON TRACK ................................................................................................... 13

LEARNER INTRODUCTION ..................................................................................................................... 15

LEARNING CONTRACT1 ........................................................................................................................... 17 PHARMACEUTICAL CARE ....................................................................................................................... 21

REQUIREMENTS AND MARKING SCHEME FOR CARE PLANS ...................................................... 39

ALLERGY ASSESSMENT ........................................................................................................................... 41

ALLERGY ASSESSMENT FORM ................................................................................................................... 43

DRUG INFORMATION REQUEST (DIR)1 ..................................................................................................... 45

DIR Requirements and Marking Scheme ......................................................................................... 49

INTERPROFESSIONAL EDUCATION (IPE) ......................................................................................... 51

PATIENT CARE PRESENTATION .................................................................................................................. 53

PATIENT CARE PRESENTATION EVALUATION FORM .................................................................. 57

GRADING SYSTEM ....................................................................................................................................... 61

LEARNING PORTFOLIO COVER PAGE ........................................................................................................ 63

SUMMARY OF LEARNING PORTFOLIO SUBMISSION ............................................................................. 65

PRACTICE EDUCATOR EVALUATION OF THE STUDENT: PHAR489 ........................................ 67

PRACTICE EDUCATOR EVALUATION OF THE PROGRAM AND ACTIVITIES: PHAR489 ...... 71


ACKNOWLEDGEMENT We would like to thank all pharmacy practice educators, coordinators and managers who have provided us with their thoughtful suggestions to enhance the UBC Faculty of Pharmaceutical Sciences Experiential Education program. We thank the many individuals who generously allowed us to adapt their materials in revising our learner handbooks and policies. In particular we would like to acknowledge Ann Thompson, Andrea Cameron, Harriet Davies and Doreen Leong for so graciously allowing us to adapt materials from their respective groups. These handbooks would not have been possible without the hard work of Alice Wang and Deanna Lo, two of our entry to practice learners in 2012, who compiled the materials and wrote the learner handbooks for each of the clerkship courses. We would also like to thank the following individuals for their past contributions to the experiential program: Marguerite Yee, Amin Bardai and Rosemin Kassam. Thank you to the following groups and individuals for their encouragement and sharing of ideas: College of Pharmacists of British Columbia British Columbia Pharmacy Association Canadian Society of Hospital Pharmacists Drug and Poison Information Centre Faculties of Pharmacy: Dalhousie University Ms. Harriet Davies

Memorial University of Newfoundland Ms. Wanda Spurell

Université de Montréal Dr. Ema Ferreira

Université Laval Ms. Celine Brunelle

University of Alberta Dr. Ann Thompson

University of Manitoba Ms. Kelly Brink

University of Saskatchewan Ms. Shauna Gerwing

University of Toronto Ms. Andrea Cameron

University of Waterloo Mr. Anson Tang

The Office of Experiential Education Team

Angela Kim-‐Sing, Paulo Tchen, Jas Jawanda, Michael Legal, Neelam Dhaliwal, Aileen Mira

Tricia Murray, Shanu Sandhu, Frances Simpson, & Louise Jingco


INTRODUCTION Experiential Education in the UBC Faculty of Pharmaceutical Sciences program comprises 25% of the curriculum and is integral to student learning. The Office of Experiential Education works closely with pharmacists to coordinate the clinical experiences of learners. The primary objective of experiential education is to assure that each learner under the supervision and guidance of a qualified pharmacist practice educator, gains valuable hands-‐on experience in a variety of practice settings. Learners complete twenty weeks of experiential education beginning with the introductory rotations in second and third year, and continuing through to the advanced rotations in fourth year. These rotations or clerkships are structured to allow for progressive learner responsibilities. Learners develop communication and technical skills, apply knowledge, and make patient care decisions based on clinical competency and professional judgment, in real world, work environments. The Office of Experiential Education currently organizes 1000 placements a year (Entry to Practice, SPT-‐International Pharmacy Graduates and SPT-‐Regulated Technicians) and works with over 500 sites to provide learners with broad exposure to as many pharmacy activities and practice settings as possible. We are very grateful to our pharmacy practice educators who enthusiastically embrace our learners at their practice sites. The rotations allow learners to actively participate in direct patient care, interact with diverse patient populations and provide opportunities for interprofessional collaboration. Through personal study and reflection, learners gain new knowledge, confidence and responsibility as they transition from learner to practitioner.

To all of our pharmacy practice educators, we thank you for taking on this critical role to partner with us in clinical education. We thank you for taking on this responsibility given all the other responsibilities you already have. We are committed to the success of both our learners and practice educators and we encourage you to provide us with program feedback. Yours Sincerely,

Angela Kim-‐Sing Director, Office of Experiential Education


GLOBAL OBJECTIVES The goal of First Professional Degree Programs in Pharmacy (FPDPP) in Canada is to graduate Medication Therapy Experts. This requires graduates to integrate knowledge, skills and attitudes from all seven educational outcomes. Via this integration, graduates are educated to meet the competencies required of Canadian pharmacists as described by the profession. These competencies include roles relating to care and services for individual patients as well as roles emphasizing the responsibilities of pharmacists to populations of patients, to their communities and to the profession itself. In addition, graduates who are Medication Therapy Experts are educated to fulfill roles beyond those required of pharmacists, acknowledging that the goal of university education extends beyond solely preparing graduates to enter into pharmacy practice. Educational Outcomes* Care Provider: Pharmacy graduates use their knowledge, skills and professional judgment to provide pharmaceutical care and to facilitate management of patient’s medication and overall health needs. Communicator: Pharmacy graduates communicate with diverse audiences, using a variety of strategies that take into account the situation, intended outcomes of the communication and the target audience. Collaborator: Pharmacy graduates work collaboratively with teams to provide effective, quality health care and to fulfill their professional obligations to the community and society at large. Manager: Pharmacy graduates use management skills in their daily practice to optimize the care of patients, to ensure the safe and effective distribution of medications, and to make efficient use of health resources. Advocate: Pharmacy graduates use their expertise and influence to advance the health and well-‐being of individual patients, communities, and populations, and to support pharmacist’s professional roles. Scholar: Pharmacy graduates have and can apply the core knowledge and skills required to be a medication therapy expert, and are able to master, generate, interpret and disseminate pharmaceutical and pharmacy practice knowledge. Professional: Pharmacy graduates honour their roles as self-‐regulated professionals through both individual patient care and fulfillment of their professional obligations to the profession, the community and society at large. * http://www.afpc.info/sites/default/files/AFPC%20Educational%20Outcomes.pdf Graduates should also recognize the four domains of the Model of Practice for Canadian Pharmacists (MSOP) developed by the National Association of Pharmacy Regulatory Authorities (NAPRA). These domains encompass standards against which pharmacist’s performance can be evaluated when the pharmacists are undertaking the activities imperative for safe and effective practice in their daily work.


The Four Domains of MSOP for Canadian Pharmacists are: 1) Expertise in medications and medication-‐use* 2) Collaboration 3) Safety and Quality 4) Professionalism and Ethics *http://129.128.180.43/Content_Files/Files/Model_Standards_of_Prac_for_Cdn_Pharm_March09.pdf

ASSESSMENT MEASURES The preceptor will complete an evaluation of the student every two weeks using the Practice Educator Evaluation of the Student Form. All evaluations are discussed with the student. Only the written summative evaluation is forwarded to the Course Coordinator. The summative evaluation shall incorporate the preceptor’s subjective evaluation of the student’s performance and an evaluation of any oral presentations or written assignments that have been completed by the student. The learner and preceptor should review the Practice Educator Guide to Student Assessment.


PHARMACY 489


PHARMACY 489 CLERKSHIP ACTIVITIES Use this list to help schedule activities and to review progress in completing required activities/assignments.1,2,3

Care Provider

! Expectations for student caseload should be sufficient to challenge the student. Students are encouraged to provide care to as many patients as possible. As a guideline, students might be expected to carry between 5-‐10% of a pharmacist’s normal daily client/patient load. At a minimum, students are expected to provide care to eight (8) patients. Students are expected to participate in ALL components of pharmaceutical care -‐ this does not mean that a student must be involved in the same patient’s care from the assessment to follow up; it does mean that the student practices each component of pharmaceutical care at some time or another during the rotation. However, for at least one patient the student should be involved in the complete pharmaceutical care process -‐ assessment, care plan, monitoring, documentation, and follow-‐up. The student should submit the complete pharmaceutical care process documentation for this one patient.

! Review all recommendations with the preceptor prior to discussing with the physician or other health care providers.

! Provide service as required e.g. Medication Reconciliation, Nursing In-‐services, Patient Medication Profile Reviews, Discharge Counseling, ADR reporting, Drug Usage Evaluation, Formulary Requests, Chart reviews.

Communicator ! Participate in clinical documentation for charting according to the requirements and guidelines of the

institution. ! Participate in patient care rounds and conferences. ! Present Information -‐ Patient care presentation in week 4. ! Participate in regularly scheduled preceptor meetings to discuss patients' progress and care provided. ! Use communication technology appropriately.

Collaborator ! Acknowledge and respect the roles and responsibilities of the pharmacist, the patient and/or caregivers, and

the patient’s other health care professionals ! Discuss with preceptor how to best collaborate with the patient’s other health care providers. ! Inter-‐professional Education Activity Series Assignment (preceptor review not required).

Manager ! Participate in ADR reporting policies and procedures as required. ! Manage personal practice. Set priorities and manage time to balance patient care, workflow and practice.

Advocate ! Incorporate health promotion recommendations into the patient’s care plans. ! Determine what health promotion prevention programs are available in the patient’s community.

Scholar ! Demonstrate an understanding of the fundamental knowledge required of pharmacists and apply this

knowledge in daily practice. ! Educate patient’s regarding medications and appropriate medication use, including the pharmacist’s role. ! Apply principles of scientific inquiry and critical thinking. ! Provide three (3) drug information searches as part of researching information for patient care or in response

to requests from health care team. Professional

! Practice within the boundaries and scope of your knowledge and skills. ! Demonstrate professionalism at all times. ! Practice in an ethical manner, which assures primary accountability to the patient.

1Adapted with permission: 2011-‐2012 Structured Practical Experience Program, Leslie Dan Faculty of Pharmacy, University of Toronto.

2Adapted with permission: The Faculty of Pharmacy and Pharmaceutical Sciences, Office of Experiential Education, University of Alberta, June 2012. 3AFPC -‐ Educational Outcomes for First Professional Degree Programs in Pharmacy in Canada. Scholar Section: 2010


The following is a guide to help you plan out the required activities during your clerkship. Please keep in mind that the timing of activities may vary due to site-‐ and preceptor-‐ specific circumstances.

SUGGESTED GUIDE TO KEEP ON TRACK

Wee

k 1

Monday Tuesday Wednesday Thursday Friday

� Orientation to pharmacy & staff. � Orientation to nursing unit. � Orientation to DIR Resources.

Review completed Learning Contract with Preceptor

§ Reflect on activities

completed this week. § Have a plan for Week 2.

! Share learner introduction form with preceptor. ! Shadow Preceptor in interactions with patients and healthcare providers. ! Identify two patients to work up ! Complete one Medication Teaching/Discharge Counseling ! Review patients with your preceptor. ! Review learning contract with preceptor by Day 3. ! Complete one (1) drug information request. ! Work on DIR and care plans at home.

Wee

k 2

Monday Tuesday Wednesday Thursday Friday ! Identify two new patients to work up ! Participate in medication profile review on the unit or dispensary and discuss

with preceptor ! Complete two (2) Medication Teaching/Discharge Counseling. ! Plan case presentation with preceptor (date, time, audience, topic) ! Complete one (1) drug information request. Review with preceptor ! Participate in IPE activity ! Plan case presentation with preceptor (date, time, audience, topic) ! Review patients with your preceptor. ! Work on DIR and care plans at home.

Midpoint evaluation § Revisit Learning Contract. § Reflect on activities

completed this week. § Have a plan for Week 3.

Wee

k 3

Monday Tuesday Wednesday Thursday Friday ! Identify two new patients to work up ! Complete two (2) Medication Teaching/Discharge Counseling ! Critically review one article with preceptor informally or present critical

appraisal of primary literature at a journal club ! Complete one (1) drug information request. Discuss with preceptor. ! Participate in IPE activity ! Review patients with your preceptor. ! Work on DIR and care plans at home.

§ Reflect on activities completed this week.

§ Have a plan for Week 4.

Wee

k 4

Monday Tuesday Wednesday Thursday Friday ! Present patient care presentation ! Review patients with your preceptor ! Complete all written assignments for preceptor to review by Wednesday of

Week 4 ! Provide preceptor with feedback

Final evaluation § Revisit Learning Contract. § Complete "Reflection of

Learning". § Ensure all documentation in

order.


LEARNER INTRODUCTION To be reviewed with Preceptor

with 72hr Checklist

1. Pharmacy volunteer experience (including site name, length of time, and hours/week): 2. Pharmacy work experience (including site name, length of time, and hours/week): 3. Previous OEE clerkship rotations (if applicable): 4. Pharmacy-‐related areas (knowledge, skills, and abilities) in which I feel most confident: 5. Pharmacy-‐related areas (knowledge, skills, and abilities) in which I feel least confident: 6. Areas of pharmacy practice in which I am most interested: 7. Any other information that may impact my learning that the preceptor should be aware of (e.g. personal issues, scheduling/transportation issues, etc.):


LEARNING CONTRACT1 In Practice: Practicing pharmacists must engage in self-‐directed learning to remain updated and current; the continued expansion of the scope of practice both encourages and warrants this type of growth. A learning contract is one method of implementing the concept of self-‐directed learning.2 DESCRIPTION OF ACTIVITY A Learning Contract is a written document that is developed by the student to identify learning objectives and assess his/her progress towards attaining these outcomes throughout the clerkship. Precisely, a learning objective is a statement of what the student wants to achieve at the end of a learning period. A realistic and attainable learning objective must consider the context of the site, available resources, and time frame. They can be knowledge or skill based in nature; knowledge related objectives are generally centered on certain therapeutic topics while skill related objectives pertain to learning “how” to complete a task. Students are enabled to tailor their learning by determining site-‐specific and individual goals for the rotation2. The Learning Contract should enhance and guide the student’s learning process throughout their on-‐site activities2. GOAL To plan and undertake learning activities to support the maintenance of competence and professional development required of a health care professional in the fieldwork setting3. LEARNING OBJECTIVES By the end of the experience the student will have:

ü Identified and documented their own learning goals. ü Developed an action plan to assess their progress toward obtaining these objectives. ü Completed appropriate activities to achieve identified learning objectives. ü Reinforced their understanding of the role of self-‐directed and life-‐long learning in

pharmacy practice. PROCESS

1. During Week 1 of rotation, identify three site-‐specific learning objectives. 2. By the end of Week 1, review Contract with preceptor. The preceptor may help to clarify

and articulate these learning objectives, as well as assist in identifying activities or resources to support the attainment of these proposed goals. The preceptor may also suggest or make modifications to the objectives they feel are appropriate for the Clerkship.

3. At the mid-‐point evaluation, re-‐assess status of the Learning Contract with preceptor to determine which objectives have been met, and which ones still need to be met.

4. At the final evaluation, revisit the Learning Contract. Discuss with preceptor and determine success in achieving the stated learning objectives.

5. Fill out the reflection form and have preceptor sign the Contract.


COMPLETING THE LEARNING CONTRACT FORM 1. Plan: Identify three intended learning outcomes for the rotation.

• What is my learning goal and why did I choose this? • What is my primary motivation in choosing this learning goal? • Example: improve ability in conducting follow-‐up on patient cases.

2. Act • What is my action plan? • What are some learning activities to meet this learning goal? • What resources are available that can aid in achieving this? (ie: lectures, patient care

rounds, seminars, online programs, health-‐related journals) • Example (continued from above): develop and use a follow-‐up tracking sheet during

Week 1 to aid in scheduling follow ups, improve efficacy and safety monitoring endpoints with appropriate timeframes on care plans.

3. Reflect • What did I learn in relation to my goal(s)? • Have I used this learning? How will I use this learning in the future? • What future learning goal(s) did this activity trigger, if any? • Will this document be useful for maintaining continuity in learning needs as I transition

to the next rotation or out into practice? LEARNING PORTFOLIO

o One Learning Contract is submitted at the completion of each clerkship.

1 Adapted with permission from: 2011-‐2012 Structured Practical Experience Program, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario. 2 Adapted with permission: Faculty of Medicine 2003 University of Manitoba, Winnipeg, Manitoba. 3 AFPC -‐ Educational Outcomes for First Professional Degree Programs in Pharmacy in Canada. Scholar Section: 2010.

Adapted with Permission: College of Pharmacists BC, Professional Development and Assessment Program 2012. Phar 489 Handbook

Copyright © 2012 UBC Faculty of Pharmaceutical Sciences 19

LEARNING CONTRACT Student Name: Student ID: PLAN What is my learning goal? Why did I choose this? What is my primary

motivation in choosing this learning goal? 1.

2. 3. ACT

What were my learning activities to meet my learning goal? Describe the workplace learning that helped me meet this objective (e.g. discussion with preceptor, peers, “hands-‐on” learning). 1.

2.

3.

REFLECT What did I learn in relation to my goal? How will/have I used this learning? What future learning goal(s) did this activity trigger? Student’s Signature _________________________________ Date______________________ Preceptor’s Signature _______________________________ Date______________________

Adapted with Permission: College of Pharmacists BC, Professional Development and Assessment Program 2012. Phar 489 Handbook


Adapted with Permission: College of Pharmacists BC, Professional Development and Assessment Program 2012.


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PHARMACEUTICAL CARE In Practice: Pharmaceutical care is a primary responsibility of the pharmacist, although shared with physicians and other health care providers. Pharmacists may provide this service directly to patients or their caregivers; or they may manage/supervise or teach/train others to provide this care. Thus the ‘client’ may vary depending on the specific responsibility pharmacists have in this role.1

DESCRIPTION OF ACTIVITY A care plan is a plan developed by the client and pharmacist working together to achieve agreed upon outcomes. This may include resolving the patient’s drug-‐related problems, meeting therapeutic goals for the patient’s medical conditions and preventing development of future drug-‐related problems. The plan may be simple or detailed, verbal or documented. This varies depending on the individual client’s requirement. The plan must include a desired outcome linked to the client(s), identified problem(s), and monitoring parameters.1 GOAL To provide safe and effective medication management to patients using the pharmaceutical care process.1

LEARNING OBJECTIVES By the end of the experience the student will have demonstrated the ability to1:

ü Assess the client’s health status and needs. ü Develop a care plan with the client. ü Support the client to implement the care plan. ü Support and monitor the client’s progress with the care plan. ü Document findings, follow-‐ups, recommendations, information provided and client

outcomes.

PROCESS1 1. Assess the client’s health status and needs

Activity 1 Establish and maintain a relationship with the client Indicators of good practice • An effort is made to establish trust and respect. • A safe, quiet and private environment is created, as feasible. • Confidentiality is maintained. • Client is encouraged to express his/her needs and views. • Role, responsibilities and accessibility of the pharmacist in supporting the client is

clarified. • Barriers to communication and other limitations are identified and evaluated.

Phar 489 Handbook Copyright © 2012 UBC Faculty of Pharmaceutical Sciences

22

Activity 2 Obtain information about the client's health Indicators of good practice • Relevant providers of information are determined. • Client's medical history and other relevant information is obtained from appropriate and

reliable sources. • Client's characteristics, beliefs and lifestyle factors pertaining to health are determined

and discussed. • Client's signs, symptoms and health parameters are accurately evaluated. • Information obtained is relevant, accurate and current. • Questions and information are communicated in a manner that promotes client

understanding. • Client is encouraged to participate in the discussion. • Client’s understanding is verified. • Information relating to the client's health is documented.

Activity 3 Determine the client's desired health outcomes and priorities Indicators of good practice • Client’s expectations are determined, discussed and clarified. • Measurable therapeutic objectives are established with the client and other healthcare

providers, as appropriate.

2. Develop a care plan with the client

Activity 1 Formulate care plan options Indicators of good practice • Options are relevant to the client's expectations, priorities and limitations. • Options reflect accepted pharmacotherapeutic practice. • Financial considerations are discussed with the client.

Activity 2 Make recommendations to meet the client's need Indicators of good practice • Recommendations are communicated in a manner that promotes understanding. • Benefits and drawbacks of recommendations are discussed with the client.

Activity 3 Support the client to select (a) care plan option(s) Indicators of good practice • Client is encouraged to evaluate and select option(s). • Client is given adequate time to reflect on options. • Client concerns and questions are responded to appropriately and respectfully. • Client is given information to help in the decision making process.


23

• Information provided is supported by literature and appropriate to the client’s needs. • Pharmacist respects the client’s decision.

Activity 4 Refer the client to other services Indicators of good practice • Referral information is accurately presented in a timely manner. • Information reflects available and accessible services in the community. • Information is conveyed in a manner that promotes client understanding.

3. Support the client to implement the care plan Activity 1 Enable the client to maximize health outcomes Indicators of good practice • Therapeutic objectives are confirmed with the client. • Client’s understanding of therapy is confirmed.

Activity 2 Provide drug therapy and devices Indicators of good practice • Drug therapy and devices are provided in a manner that reflects legal and professional

requirements. • Instructions are provided in a manner that promotes client understanding. Activity 3 Provide information Indicators of good practice • Information provided is relevant, accurate and current. • Information is conveyed in a manner that promotes client understanding. • Information includes non-‐drug therapy options, as relevant to desired health outcomes. • Appropriate written information and reference sources are provided to support the

client’s management of therapy.

4. Support and monitor the client's progress with the care plan

Activity 1 Obtain and evaluate information on the client's progress with the care plan Indicators of good practice • Needed follow-‐ups with the client are conducted. • Information is gathered as appropriate. • Changes in health and health care are evaluated. • Compliance is assessed and positively reinforced.

Activity 2 Confirm or modify the client’s care plan Indicators of good practice


24

• Options are reviewed, evaluated and modified with the client. • Client is given adequate time to reflect on changes. • Modified care plan reflects the needs of the client.

5. Document findings, follow-‐ups, recommendations, information provided and client outcomes

Activity 1 Document information Indicators of good practice • Information is relevant, accurate and current • Information meets legal and professional requirements • Confidentiality is maintained • Records are up-‐to-‐date, relevant and accurate

Activity 2 Maintain and store information Indicators of good practice • Access to information is controlled and integrity of records is protected • Electronic files are backed-‐up in case of data loss • Effective methods are used • Records are maintained for an appropriate length of time • Maintenance and storage systems meet legal and professional requirements

COMPLETING THE CARE PLAN2

1. This activity is the major focus of the experiential education rotations and requires the greatest commitment of time from the learner.

2. Learners are expected to provide components of pharmaceutical care for each patient to whom they are assigned. While the specific format for care plans may vary, it should be consistent with the principles of pharmaceutical care outlined in Cipolle RJ, Strand LM, Morley PC Pharmaceutical Care Practice: The Clinician’s Guide, McGraw Hill, 2004.

3. Care should be provided for a wide range of therapeutic areas. Students are encouraged to consider their personal learning objectives within the Learning Contract to ensure breadth of therapeutic topics are covered during experiential learning.

4. Quantity: In each 8 and 4-‐week rotation, students must provide components of pharmaceutical care for a minimum of 16 and 8 patients respectively. Students are encouraged to provide care to as many patients as possible. Expectations for student caseload should be discussed early in the rotation (See “72 Hour Checklist”).

5. Therapeutic Diversity: Students are expected, to the extent possible, to care for patients with acute and chronic illnesses, and in various life stages, by the end of the rotations. During the rotation, students are expected to enter into an effective dialogue and professional relationship with those patients that are reasonably able and willing to work with the student. In some cases, the student may also enter into dialogue with a patient’s family member and/or caregiver.

1 Adapted with permission from: 2006 Framework of Professional Practice, College of Pharmacists of British Columbia. 2 Adapted with permission from: 2012 Structured Practical Experience Program, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario.

Phar489 Handbook


6. Patient/Client Selection: The preceptor may initially help students select patients for whom they will provide care. Since students are well versed in the treatment of diabetes, asthma, hypertension, congestive heart failure, chronic obstructive pulmonary disease and urinary tract infection, patients with these illnesses would make good initial selections, if appropriate to the rotation site. As students gain familiarity with the setting and patients, preceptors will be less involved in aiding students in patient selection. In community rotations, opportunities for provision of pharmaceutical care may arise, for example, during non-‐prescription medication consultation, upon receipt of a new prescription, during a repeat prescription visit with a new patient, upon hospital discharge, and upon physician or other health care professional referral. In institutional rotations, opportunities for provision of pharmaceutical care may arise, for example, during admission medication history taking, upon receipt of a new or changed medication order, in preparation for discharge, during a regular medication review, upon review of an order for a non-‐formulary drug or a high cost/high risk drug, and upon physician or other health care professional referral.

7. Comprehensiveness: Care can be provided for patients with simple drug therapy problems or those with more complex problems. Regardless of the patient scenario, all components of the pharmaceutical care process are to be completed.

8. Documentation: Documentation of care on paper or electronic files, charts, inter-‐ and intra-‐professional locations must be completed to the standards applicable in the given site. Practice requirements and level of independence in documentation should be discussed early in the rotation (see 72 hour checklist).

LEARNING PORTFOLIO Before submission:

o Review Grading Rubric for care plans. o Submit only one patient care workup with a care plan for each medical condition (including

Assessment Form, allergy assessment, care plan(s), monitoring plan, and follow-‐up evaluation forms).

o Submit only your best work (comparable to the acceptable examples provided on course website).

o The patient workup submitted should be independent of any other patient’s you have worked up for the DIR or case presentation.

o Review with your preceptor – verbal okay. o Ensure patient confidentiality and remove patient identifiers.


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Adapted with permission from: © 2009 Copyright Medication Management Canada and 2003-‐2005 Peters Institute of Pharmaceutical Care, Cipolle RJ, Strand LM, Morley PC Pharmaceutical Care Practice: The Clinician’s Guide, McGraw Hill, 2004


27

STUDENT NAME: _______ STUDENT #: ________

Pharmacotherapy Workup© NOTES ASSESSMENT

CO

NTA

CT

INFO

RM

ATI

ON

Name

Address

City

Province

Postal Code

Telephone (h)

(w)

(cell)

e-mail

Physician (address)

(tel) (fax)

Specialist (address)

(tel) (fax)

DEM

OG

RA

PH

ICS

Age Date of Birth (D/M/Y) Gender

Weight Height Ethnicity

Pregnancy status Due Date/Trimester Breast Feeding

Occupation Living Arrangements/Family

Personal Health Number Third Party Plan

REASON FOR ENCOUNTER

MED

ICA

TIO

N*

EX

PER

IEN

CE

What is the patient’s general attitude toward taking medication?

Needs attention in care plan

What does the patient want/expect from his/her drug therapy?


What concerns does the patient have with his/her medications?


To what extent does the patient understand his/her medications?


Are there cultural, religious, or ethical issues that influence the patient’s willingness to take medications?


Describe the patient’s medication taking behaviour


Medication*= drug includes: prescription, non-prescription, and natural health products



28

IMM

UN

IZA

TIO

NS

Current on all childhood immunizations

AD

ULT

IM

MU

NIZ

ATI

ON

S*

ROUTINE 18 YEARS +

RECOMMENDED 65 YEARS +

DOSING SCHEDULE (NO RECORD OR UNCLEAR

HISTORY OF IMMUNIZATION)

BOOSTER SCHEDULE (PRIMARY SERIES COMPLETED)

Current on all adult immunizations

* see http://www.phac-aspc.gc.ca/im/is-cv/index-eng.php#a for more information



29

SO

CIA

L D

RU

G U

SE

SUBSTANCE HISTORY OF USE SUBSTANCE HISTORY OF USE

Tobacco

No tobacco use

0-1 packs per day >1 packs per day previous history of smoking attempts to quit

Alcohol

No alcohol use

< 2 drinks per week 2-6 drinks per week > 6 drinks per week history of alcohol dependence

Caffeine

No caffeine use

< 2 cups per day 2-6 cups per day > 6 cups per day history of caffeine dependence

Other recreational drug use:

ALL

ERG

IES

& A

LER

TS

Medication Allergies (drug, timing, reaction—e.g., rash, swelling, shortness of breath, anaphylaxis)

Adverse reactions to drugs in the past

Other Alerts/Preferences/Health Aids/Special Needs (e.g., sight, hearing, mobility, literacy, disability)

CU

RR

ENT

MED

ICA

L C

ON

DIT

ION

S A

ND

MED

ICA

TIO

NS

MEDICAL CONDITION MEDICATION DOSAGE REGIMEN START DATE RESPONSE*

EFFECTIVENESS, SAFETY

*stable, improved, partially improved, worsened, resolved, failed



30

PA

ST D

RU

G T

HER

AP

IES

MEDICAL CONDITION DRUG THERAPY RESPONSE* EFFECTIVENESS/SAFETY DATE

*stable, improved, partially improved, worsened, resolved, failed

PAST MEDICAL HISTORY (RELEVANT ILLNESSES, HOSPITALIZATIONS, SURGICAL PROCEDURES, INJURIES, PREGNANCIES)

RELEVANT FAMILY HISTORY (E.G. GENETICALLY ASSOCIATED CONDITIONS)



31

NUTRITIONAL STATUS OR DIETARY RESTRICTIONS/NEEDS/EXERCISE



32

DRUG THERAPY PROBLEMS TO BE RESOLVED

DR

UG

TH

ERA

PY

PR

OB

LEM

S

MEDICAL CONDITION AND MEDICATION(S) INVOLVED (PROVIDE RATIONALE FOR DTP SELECTION)

NECESSARY Unnecessary Drug Therapy

(e.g. no medical indication, addictive/recreational, nondrug therapy indicated, duplicate therapy, treating avoidable ADR)

Needs Additional Drug Therapy

(e.g. untreated condition, synergistic/potentiating, preventive/prophylactic)


EFFECTIVENESS Ineffective Drug

(e.g. dosage form inappropriate, condition refractory to drug, not effective for condition, more effective drug available)

Dosage Too Low

(e.g. ineffective dose, frequency too long, duration too short, incorrect storage, incorrect administration, drug interaction)


SAFETY Dosage Too High

(e.g. dose too high, frequency too short, duration too long, drug interaction)

Adverse Drug Reaction

(e.g. unsafe drug for patient, allergic reaction, incorrect administration, drug interaction, dosage increase/decrease too fast, undesirable effect, contraindications present)


ADHERENCE Non-adherence

(e.g. drug product not available, cannot afford drug product, cannot swallow/administer, directions not understood, patient prefers not to take, patient forgets to take)

No Drug Therapy Problems at this time

Signature:________ Date: __________

Adapted with Permission: St.Paul's Hospital Pharmacy, Providence Health Care, Vancouver 2004


33

REVIEW OF SYSTEMS:

Signs, Symptoms, Lab value List deviation from normal (and relevant baseline values)

If abnormal, can it be caused by

patient’s medications?

Date VITAL SIGNS:

Temp BP HR RR CNS / NEUROLOGIC

Confusion Drowsiness Dizziness Fatigue Numbness Tingling EENT

Voice change Swallowing problem Taste change CVD

T. cholesterol LDL / HDL CO SOB Edema Palpitation PULMONARY

SOB Wheezing Coughing Phlegm/Blood Peak Flow FLUID & ELECTROLYTE

Na+ K+ Ca Cl- HCO3 Mg2+

Adapted with Permission: St.Paul's Hospital Pharmacy, Providence Health Care, Vancouver 2004


34

REVIEW OF SYSTEMS - continued

Signs, Symptoms Lab value

List deviation from normal (and relevant baseline values) If abnormal, can it be caused by patient’s

medications? Date RENAL

Se. Cr. CrCl LIVER

AST ALT Albumin Bruising Bleeding GI

GU / Reproduction

ENDOCRINE

Se. Glucose HgA1C TSH T4 MSK

DERMATOLOGY

HEMATOLOGY

Hgb Platelets WBC Neutrophils INR PTT DRUG LEVELS

Digoxin Theophylline Lithium CULTURES

Modified with The Faculty of Pharmacy and Pharmaceutical Sciences, Office of Experiential Education, University of Alberta, June 2012


35

STUDENT NAME: _______ STUDENT #: ________

PH

AR

MA

CO

THER

AP

Y P

LAN

MEDICATION RECOMMENDATION(S)

OTHER RECOMMENDATION(S) (E.G., NON-DRUG MEASURES, REFERRALS)

RATIONALE FOR RECOMMENDATION(S)

Pharmacotherapy Workup © NOTES CARE PLAN PATIENT INITIALS: DATE:

MEDICAL CONDITION AND ASSESSMENT (NESA)

GOALS OF THERAPY

DRUG THERAPY PROBLEM(S) TO BE RESOLVED



36

REFERENCES TO SUPPORT RECOMMENDATION(S)

ACTION:

MD contacted in writing MD contacted by phone MD not contacted Patient as primary contact Other HC providers contacted Others contacted:

RECOMMENDATION WAS:

MD accepted pharmacist’s original recommendation MD didn’t accept recommendation & didn’t have an acceptable rationale Patient accepted recommendation MD did not accept recommendation but had an acceptable rationale Recommendation modified after consultation with MD Patient did not accept recommendations

MONITORING PLAN

EFFE

CTI

VEN

ESS

OUTCOME PARAMETER Monitored By EXPECTED CHANGE DATE

Sign/symptom

Sign/symptom

Laboratory value

Laboratory value

SA

FETY

Sign/symptom

Sign/symptom

Laboratory value

Laboratory value

SIGNATURE:________ DATE: _________ Adapted with permission from: © 2009 Copyright Medication Management Canada and 2003-‐2005 Peters Institute of Pharmaceutical Care, Cipolle RJ, Strand LM, Morley PC Pharmaceutical Care Practice: The Clinician’s Guide, McGraw Hill, 2004



37

Student Name: _______ Student #: ________ Pharmacotherapy Workup © NOTES FOLLOW UP EVALUATION

PATIENT INITIALS: DATE:

MEDICAL CONDITION

EFFE

CTI

VEN

ESS

Outcome Parameter Baseline

DATE:

1st Evaluation

DATE:

2nd Evaluation

DATE:

Sign/symptom

Sign/symptom

Laboratory value

Laboratory value

SA

FETY

Sign/symptom

Sign/symptom

Laboratory value

Laboratory value

OU

TCO

ME

STA

TUS

Initial: goals being established, initiate new therapy Resolved: goals achieved, therapy completed Stable: goals achieved, continue same therapy Improved: adequate progress being made, continue same therapy Partial Improvement: progress being made, adjustments in therapy required Unimproved: no progress yet, continue same therapy Worsened: decline in health, adjust therapy Failure: goals not achieved, discontinue current therapy and replace with different therapy

New Drug Therapy Problems Identified none at this time

documented none documented

DATE FOR NEXT FOLLOW-UP COMMENTS

SIGNATURE:____________ DATE: ____________ Adapted with permission from: © 2009 Copyright Medication Management Canada and 2003-‐2005 Peters Institute of Pharmaceutical Care, Cipolle RJ, Strand LM, Morley PC Pharmaceutical Care Practice: The Clinician’s Guide, McGraw Hill, 2004

Modified with permission: The Faculty of Pharmacy and Pharmaceutical Sciences, Office of Experiential Education, University of Alberta, June 2012


38



39

REQUIREMENTS AND MARKING SCHEME FOR CARE PLANS

Requirements of the Care Plan Checklist Questions for Marking 1. Patient database includes relevant patient description for the medical condition (using

data from appropriate patient interview form). Basic patient information (e.g. age, weight, BMI, allergy assessment etc.) should also be included if relevant. § Must include a list of all current medical conditions and medications (Rx, non-‐Rx),

doses, duration and indication (should attempt to determine indication if not already known/documented)

§ Patient beliefs/concerns need to be included as well as patient goals for health and wellness.

DATA o Is data presented in organized fashion? o Is proper grammar/spelling used? o Is data presented complete/comprehensive? o Patient beliefs/concerns specified (if appropriate)

2. ASSESSMENT of DTPs (based on NESA) § Identifies key issue/DTP(s) (clearly stated, prioritized)

a. Evidence of process for assessment using 5 prime areas for therapies for each medical condition: necessary, effectiveness, safety, adherence and unmet needs

b. Rationale: student is concise in identifying why this is a DTP and only includes the pertinent data relevant to the DTP(s) being addressed (point form OK)

ASSESSMENT of DTPs o Are all DTPs identified (based on 5 prime areas)?

oIf no, note which are missing o Are DTPs prioritized appropriately? o Is rationale provided for DTPs? o Is an assessment of each DTP provided (factors considered to influence/determine a plan)?

3. Desired therapeutic outcome(s)/goal(s) of intervention/recommendation incorporating patient goals

o Therapeutic outcome(s)/goal(s) stated? o Patient outcome(s)/goal(s)l incorporated (if appropriate)

4. Alternatives: Identifies at least 2 viable alternatives when appropriate, and provides reasoning and rational decision making for inclusion or exclusion of these options

o Are alternatives (with rationale for each) provided?

5. Therapeutic Plan/Recommendations and Rationale § Provides Drug and Non-‐Drug Measures § Considers other therapeutic alternatives for the patient § Provides rationale for all treatment options § Provides an appropriate assessment for resolving the DTP § Incorporates PK dosing (if applicable) mg/kg, mcg/kg or units/kg, renal dosage

adjustment and patient values/preferences/goals/priorities [ie: once daily versus BID], ADR profile of drug options, medication administration abilities

§ Action taken: should be appropriate to resolve DTPs (integration of knowledge, patient values)

PLAN o Plan/recommendations are outlined including:

o dosing considerations(dose, frequency and duration) o tapering/titration schedule o patient preferences

ACTIONS TAKEN o Appropriate/acceptable action has been taken o Monitoring plan present, is patient specific and includes:

o endpoints (o safety and o efficacy) o frequency o duration (if appropriate) o expected change o date o which healthcare provider/patient will follow-‐up

o Follow-‐up plan present

o includes outcome (if possible) o who o how o when

6. Monitoring Plan § States the relevant monitoring endpoints, including safety and efficacy,

appropriate frequency, duration, expected change, date, and who is responsible for monitoring

7. Follow Up § Provides evidence that follow-‐up has been provided and assesses progress

toward the desired outcomes.

Each care plan is a maximum of four letter-‐sized pages (single-‐spaced) typed in a minimum of size 10 font.



40

Pass

Overall the quality of work submitted achieves expectations. The student displays average to above average clinical competency and complex problem solving abilities. Well organized care plan with clear delineation of Patient Assessment and Care Plan § All major DTPs are identified, prioritized and addressed in the plan in priority sequence § Able to interpret uncomplicated laboratory data (i.e. INR, Cre, Lipids, Liver Test). § Data gathered is complete, comprehensive and organized. § Competent understanding of pharmacotherapy. Uses supporting evidence (laboratory data, physical signs and

symptoms, test results) to support assessment of patient § Therapeutic knowledge is comprehensive § Therapeutic alternatives are discussed and rationale for choice is provided. § Recommendations are supported -‐ Cites major studies and places them in context of the patient. § Care plan is logical and effective. Competent documentation that demonstrates understanding of issues

directly relevant to the patient. § Monitoring plan is appropriate and complete. § Follow up is complete and appropriately conducted. § Uses correct grammar, punctuation, spelling and formatting conventions in the preparation of care plan.

Supplemental Please refer to the Supplemental Process in OEE Course Policies Handbook for more information

Overall the quality of work submitted is unacceptable (i.e. below average). The student fails to adequately demonstrate clinical competency and problem solving ability. There are concerns about the care provided and the student will be given the opportunity to present the same care plan verbally. § No major DTPs missed, only minor DTPs omitted. § Able to interpret uncomplicated laboratory data (i.e. INR, Cre, Lipids, Liver Test). § Data gathered is appropriate but may be missing minor details that have minimal impact on the care provided. § Basic understanding of pharmacotherapy in the assessment or rationale. § Needs to broaden therapeutic knowledge base -‐ only minor gaps in knowledge base and understanding of

pharmacotherapy. Able to provide therapeutic alternatives but requires more in depth evaluation of therapies in rationale.

§ Recommendations are not fully supported – major studies are placed out of context of the patient. § Care plan not always logical or effective. Some parts are difficult to follow and to understand with noticeable

errors. § Monitoring plan incomplete but not missing key information. § Follow up is not done or missing key information. § Uses correct grammar, punctuation, spelling and formatting conventions in the preparation of care plan.

Fail

Overall the quality of work submitted is unacceptable (i.e. below average). The student has significant gaps in knowledge base and understanding of the patient and pharmacotherapy, resulting in errors in decision making that may harm a patient or put a patient at unnecessary risk. § Major DTPs missed in work up of patient. § Unable to interpret uncomplicated laboratory data (i.e. INR, Cre, Lipids, Liver Test). § Data gathering is poor -‐ omits and/or misinterprets patient details that could impact therapy decision-‐making § Needs to broaden therapeutic knowledge base – obvious gaps in therapeutic knowledge base, understanding

of pharmacotherapy is weak or not evident, examples: § Indication for medications is incorrect or not clear § Dosing recommendation for a medication is not provided § Dosing recommendation for a medication is harmful or suboptimal § Unable to apply pharmacotherapy knowledge to a specific patient § Unable to provide rationale for therapeutic plan § Unable to provide patient specific therapeutic alternatives

§ Recommendations are not supported -‐ fails to cite or misses relevant major studies, fails to assimilate previous pharmacology knowledge.

§ Care Plan is disorganized -‐ repetitious, misplaced information that hinders understanding of the care provided § Monitoring plan is incomplete -‐ nonspecific and/or missing key information. § Follow up is not done or inappropriately conducted/documented. § The action taken to resolve the DTP is inappropriate e.g. discontinuation or reduction of prescribed medication

without consultation with physician. § Fails to use correct grammar, punctuation, spelling and formatting conventions in the preparation of care plan.

1 Cipolle RJ, Strand LM, Morley PC Pharmaceutical Care Practice: The Clinician’s Guide, McGraw Hill, 2004. Phar489 Handbook


ALLERGY ASSESSMENT In Practice: Medication allergies can be confusing to patient and practitioner alike. Frequently patients have been told they had an allergic reaction, or they suspect an allergic reaction themselves, when he/she actually experienced an adverse reaction to a drug product.1 DESCRIPTION OF ACTIVITY An essential part of any assessment of a patient's drug-‐related needs is your patient's drug allergies. Care should be taken to be specific when gathering drug allergy information from the patient. Patients should not be exposed to a product that has produced a true allergic reaction, so a portion of your responsibility is to separate true allergic responses from adverse drug reactions. This may be difficult with the limited history and/or memory the patient has of the event. However, this information will directly impact your choice of drug products to be used in a patient.1 GOAL To accurately assess and document drug allergy information as part of a patient assessment. LEARNING OBJECTIVES By the end of the experience the student will:

ü Be familiar with the presentation, timing, and common drugs involved in allergic reactions.

ü Be able to and understand the importance of separating true allergic responses from adverse drug reactions.

ü Gather specific drug allergy information from the patient and document responses. ü Educate the patient on the differences between a true allergic reaction and an adverse

drug reaction as necessary.

PROCESS 1. Ask each patient about his/her drug allergy history. 2. Be sure to ask about the nature of the allergic response, the product that caused the

reaction, and the timing of the reaction. 3. Document their response on the allergy assessment form. 4. Educate the patient about the difference between an allergic reaction and an adverse

drug reaction or drug intolerance as applicable. LEARNING PORTFOLIO Submit:

o A patient-‐specific allergy assessment form as part of your pharmaceutical care workup. o Complete one allergy assessment form per drug allergy.


42


43

ALLERGY ASSESSMENT FORM Please use a separate form for each medication the patient has identified as an allergy.

Patient: Pharmacist: Date:

Drug Allergies

1. Name of the medication to which patient reacted

2. In what year did the allergic reaction occur?

3. How was the medication given? Orally Intravenously Injection Other:

4. Does the patient remember how soon after taking this medication the reaction occurred?

Within 24 Hours 1-‐3 Days >3 days

5. What type of reaction did the patient have? (Check all that apply) Hives/Welts Shortness of breath/trouble breathing Wheezing Chest tightness Tightness in throat Passed out Nausea, vomiting, diarrhea, cramping Other type of rash – please describe

Swelling Eyes Face Lips Tongue Other (please specify):

Other type of reaction – please describe:

a) Has the patient taken this drug or similar drugs since the reaction? No Don’t know Yes – if yes, list similar meds:

b) Has the patient seen an allergist and had testing done? Yes No

Drug Allergy Assessment

! No known drug allergies ! Contraindication – drug causes life-‐threatening reaction, patient should never receive the drug. ! Caution – drug causes a moderate to severe side effect; patient should avoid if possible but may receive with

monitoring if benefit outweighs the harm

Drug Allergy – Pharmacist Action where applicable

Educate the patient on their allergy (i.e. intolerance vs. true allergy), drugs to be avoided, and refer to allergist Recommend EpiPen™ and Allergy Alert Bracelet Update allergy status on pharmacy site documentation, including Pharmanet

Does the patient have any Non Drug Allergies?

None ! Fish Eggs Peanut Lactose Contrast Media Latex Other

Adapted with Permission: Providence Health Care Practice Standard IDG1064 – Allergy/Intolerance. November 2013. Copyright© 2014 Faculty of Pharmaceutical Sciences


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45

DRUG INFORMATION REQUEST (DIR)1 In Practice: Providing drug information is intrinsic to the effective provision of direct patient care. Pharmacists are required to integrate and apply knowledge of pharmacotherapeutics, pharmacology, pathophysiology and other pharmaceutical sciences to the drug-‐related aspects of patient care, and to communicate that knowledge to other health care professionals and directly to patients. DESCRIPTION OF ACTIVITY This activity allows students to answer drug information questions that pharmacists encounter on a daily basis. At the advanced level, appropriate questions require in-‐depth research to determine the correct response. A pharmacotherapy workup2 (Necessary, Effective, Safe, Adherence) must be completed in order to answer the question. Drug information responses must be provided in an organized, thorough, accurate and timely manner. GOAL To apply the core knowledge and skills required of a medication therapy expert in the provision of drug information and recommendations.3 LEARNING OBJECTIVES By the end of the experience the student will have:

ü Documented the drug information response using scientific writing skills. ü Demonstrated progression toward competency in responding appropriately to DIRs

from patients or health care providers. ü Reinforced their understanding of the role of pharmacists in enhancing patient care

through the provision of drug information. PROCESS

1. Identify with preceptor or designate, DIRs that are routine for the practice site. Requests may come from patients, physicians, other pharmacists, or other health practitioners.

2. Complete DIRs as they arise in day-‐to-‐day practice at the site. 3. Review response to DIRs with preceptor or designate in a timely manner. 4. Under the direct supervision of a pharmacist, provide DIR response to the person

requesting the drug information either verbally or in writing, as the situation requires. 5. If new information arises that changes your DIR response, follow-‐up as required.

1 Adapted with permission from: 2011-‐2012 Structured Practical Experience Program, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario. 2 Cipolle RJ, Strand LM, Morley PC Pharmaceutical Care Practice: The Clinician’s Guide, McGraw Hill, 2004. 3 AFPC -‐ Educational Outcomes for First Professional Degree Programs in Pharmacy in Canada. Scholar Section: 2010.

Phar489 Handbook


COMPLETING THE DRUG INFORMATION REQUEST FORM 1. Fill out all relevant information when you receive the request:

• Question: Document the specific question being asked – use PICO MODEL. • Students must carefully and precisely articulate and examine the question to which

they will be providing a specific answer. • Ideally the drug information questions selected should be patient-‐care focused. • May emanate from a patient issue in which a problem is potentially drug-‐related. • May relate to issues with management of a disease. • In the institutional setting you may be asked to compare and contrast drugs for

formulary consideration. This query must take into account the clinical situation out of which the question has originated and the background of the questioner (health professional or patient), anticipating the other needs of the questioner.

2. Background information: • Provide the general context from which the question arises. • This general context may help the pharmacist formulate the real question that needs

to be answered and anticipate other information needs. • Be sure to include all relevant patient information, such as age, gender, medical

history, etc. 3. Conduct your research in order to answer the question:

• Consider the type/nature of the question (e.g. dosing, drug-‐interaction, adverse effects) to help guide the use of appropriate resources.

• Use primary resources where possible. 4. Response:

• Clearly answer the question that has been asked so that it is easy for the reader to understand or interpret.

• Address Necessary, Effective, Safe and Adherence in your assessment, followed by the recommendation and rationale under separate headings.

• Include a monitoring and follow-‐up plan. 5. References:

• Indicate all references used to procure the answer. • Where primary resources are used, it must be cited using Vancouver Style.

LEARNING PORTFOLIO Before submission, check that each DIR meets the Grading Rubric and is:

o Your best work and comparable to the examples provided on course website. o Independent of comprehensive pharmacy patient care plans. o Patient-‐specific – unless it is a compare and contrast question in the institutional

setting. o 2 to 3 pages in length. o Reviewed by your preceptor. o Anonymous (no patient identifiers).

Adapted with permission: Drug Information Form, BC Drug and Poison Information Centre, Vancouver, British Columbia 2012


47

Drug Information Request

DIR Form

Date/time required: Date/time notified/messages left:

Date Time Contacted by ☐ In person ☐ Fax ☐ Phone ☐ E-‐mail

Patient specific? ☐ Yes ☐ No Requestor

Phone

Fax/Email ☐ Patient ☐ MD ☐ Pharm ☐ RN

☐ DDS ☐ Vet ☐ Other:

Time taken (minutes): History = Research = Write-‐Up = TOTAL =

Address

Nature of Request: ☐ Therapeutics ☐ Dosage/Route ☐ ADR

☐ Interactions ☐ Pregnancy ☐ Lactation ☐ Compatibility

☐ Pharmacology ☐ Kinetics ☐ Pharmaceutics ☐ Ingredients

☐ Literature search ☐ Toxicity ☐ Alternative Medicine

Response prepared by:

Question Background Information Response (Type here or attach response) References (Attach citations -‐ Vancouver Style -‐ for any primary literature used to answer the DIR)

Therapeutics Pregnancy & Lactation ADRs & Interactions CAMS Resource Page #/Edition Resource Page #/Edition Resource Page #/Edition Resource Page #/Edition

DIR Briggs Meylers Natural Standard

CPS/eCPS BC Women's Handbook

Eval Drug Interactions

Natural Med Compr Dtbse

Martindale ReproRisk System MedEffect (Health

Canada) Review Natural Products

Therapeutic Choices

Motherisk Site

Reactions (Ingenta)

Prof Handbook Compl Med

Clinical Drug Data Hale Stockley AHFS Hansten & Home

UpToDate Drug Interaction Facts

DrugDex Davies DiPiro/Koda-‐Kimble

Lexi-‐Comp Interactions

USP DI Harrison's Online MD Consult First Consult

Phar489 Handbook


Phar489 Handbook


DIR Requirements and Marking Scheme

Date/time required: Date/time notified/messages left:

Date Time Contacted by ☐ In person ☐ Fax ☐ Phone ☐ E-‐mail

Patient specific? ☐ Yes ☐ No Requestor

Phone

Fax/Email ☐ Patient ☐ MD ☐ Pharm ☐ RN

☐ DDS ☐ Vet ☐ Other:

Time taken (minutes): History = Research = Write-‐Up = TOTAL =

Address

Nature of Request: ☐ Therapeutics ☐ Dosage/Route ☐ ADR

☐ Interactions ☐ Pregnancy ☐ Lactation ☐ Compatibility

☐ Pharmacology ☐ Kinetics ☐ Pharmaceutics ☐ Ingredients

☐ Literature search ☐ Toxicity ☐ Alternative Medicine

Response prepared by:

Question Background Information -‐ Patient/Problem § Provide all background information necessary to understand the patient (age, gender, medical

conditions, current medications -‐ doses and duration, drug allergies) and the question being asked.

§ Include any pertinent subjective/objective information.

Response -‐ Intervention, Comparison (Attach Typed Response to this sheet) § Provide a detailed but concise response to the DIR (maximum of two pages double sided, typed

in size 10 font). § Don’t just answer the question but fully discuss the thought process (N, E, S, A) relevant to the

drug. § Consider at least two other therapeutic alternatives where applicable. § Provide recommendation and rationale for decision-‐making, § Dosing Recommendations must be patient specific. Include the dose assessment (mg/kg) or

dosing range. Any titration regimen must be clearly articulated. Support your dosing recommendation with literature if it cannot be readily found in DiPiro or AHFS. Incorporate pharmacokinetic dosing and drug monitoring where appropriate (e.g. warfarin INR, digoxin, phenytoin, aminoglycosides, vancomycin, carbamazepine). Incorporate renal dosage adjustment into the therapeutic plan for patient where appropriate.

§ Address patient’s unmet therapy needs. Monitoring Plan & Outcome § States the relevant monitoring parameters. Be patient specific and include the appropriate

frequency, acceptable endpoints and duration of monitoring for both efficacy and toxicity. § States patient’s response to recommendations provided & complete follow-‐up as necessary. References (Attach citations -‐ Vancouver Style -‐ for any primary literature used to answer the DIR). Adapted with permission: Drug Information Form, BC Drug and Poison Information Centre, Vancouver British Columbia 2012.

Phar489 Handbook


Phar489 Handbook


INTERPROFESSIONAL EDUCATION (IPE) In Practice: Pharmacists collaborate with other health care providers in all practice settings to better understand and effectively meet patient needs. In community settings, interprofessional collaboration occurs as pharmacists communicate verbally via telephone, electronically with faxes or other transmissions, or in person (e.g. often with pharmacy technicians). In institutions and ambulatory settings, pharmacists are in direct contact with other professionals during interprofessional team meetings and through face-‐to-‐face interactions.1 DESCRIPTION OF ACTIVITY There are three interprofessional education activities to be completed and reflected upon:

• Activity #1: Reflection on an Interprofessional Education Session • Activity #2: Shadowing a Team Member • Activity #3: Participation in a Team Meeting

GOAL To understand the importance of interprofessional collaboration and education towards the provision of patient care. LEARNING OBJECTIVES1 By the end of the experience the learners will have:

ü Learned about the roles of other health care providers and understood how other professionals are involved in client/patient/family care.

ü Demonstrated their own role, responsibilities, values and scope of practice effectively to a patient/client/other health care provider.

ü Taken a step towards developing collaborative practice skills and knowledge. LEARNING PORTFOLIO

o IPE can be completed in any of the clerkships. Most students find it easier to complete Activities 1 and 3 in PHAR 489. Regardless of when and where you completed the IPE activities, submit the three reflection activities in the PHAR 489 Learning Portfolio.

1 Adapted with permission from: 2011-‐2012 Structured Practical Experience Program, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario.


PATIENT CARE PRESENTATION In Practice: Formal case presentations are an effective structure for presenting challenging or interesting patients, providing a context for applying evidence-‐based practice and improving patient care. Presentations are effective teaching tools and require skills pharmacists frequently call upon.1 DESCRIPTION OF ACTIVITY The objective of doing a case presentation is to give students the opportunity to make a formal presentation to their preceptor(s) and peers on a patient case they have been involved with. This exercise confronts the student with actual situations placing them in the position of making judgments based on the information presented in the case, and forcing them to discuss and analyze the situation and make certain decisions and recommendations. Students may either follow the proposed format or use an alternate format presented to them by their preceptor(s). GOAL To communicate effectively via presentation of a patient case to peers and other health care professionals.2 LEARNING OBJECTIVES By the end of the experience the student will have:

ü Prepared and delivered a practice-‐related case presentation to health practitioners, patients, care providers and/or other rotation site-‐specific audiences.1

PROCESS

1. Plan: • Select your patient care based topic with DTPs by the end of Week 1. It should

involve interesting and important aspects of medication management. • You must be the primary person involved in the care of this patient. • Cannot be the same patient as your DIR or care plan submission. • Tailor your presentation to your audience.

2. Preparation: • Structure for a 20 -‐ 30 minute talk unless specified otherwise by your preceptor (if

you are the only student at the site, you may be given 45 minutes to present). • Prepare appropriate visual aids. • Provide a handout, which allows the audience the ability to follow the discussion.

The handout must include a reference list. • Practice, practice, practice.

3. Delivery: • Tell a good story -‐ what you found, what you did, and what happened3 • Be passionate and excited, make a big effort to keep the audience interested


4. Question Period: • Usually 10 minutes • Be prepared to answer all questions related to etiology, pathophysiology, diagnosis,

diagnostic tests, differential, course of medical conditions and complications, medications and non-‐pharmacological management, follow-‐up.

CASE STUDY FORMAT4 Patient Information

Information presented should include: • Demographic data: Age, sex, race, weight (including IBW or BMI). • Chief complaint (CC): Reason for the patient's admission. • History of present illness (HPI): Brief summary of events leading to admission. • Past medical history (PMH): Brief list of all illnesses, surgical procedures,

previous hospitalizations that have a direct effect on the present illness. • Provide a list of all medications & CAM therapy patent is receiving. This is best

done in a table format. For each medication, include the indication, dose, duration of treatment & monitoring parameters.

• Address any drug and non drug allergies, or ADRs with past medications. • Social & family history: summarize relevant or contributory social & family

history. • Review of systems (ROS), physical exam data and laboratory values: Pertinent

tests used to diagnose and monitor the illness, including reference ranges. Disease State

Provide general discussion of the disease process. Remember the discussion of the disease state is important. It will be the foundation for discussing drug therapy and monitoring parameters for both efficacy and toxicity. • State the cause of disease, risk factors, symptoms, physical & laboratory

findings of a typical case. • Discuss diagnosis, prognosis, and possible complications of the disease state. • State the goals of therapy.

Drug Therapy

This discussion of the therapeutic approaches to the disease is the most important part of your presentation. Use the PICO MODEL (Evidence based medicine) to frame your discussion. • State all actual and potential drug therapy problems (DTPs). • Select one DTP and present a pharmacy care plan to resolve or prevent the

DTP. • Rationalize how you concluded this DTP existed. • Discuss feasible options for resolving the DTP based on current evidence

(consider efficacy, safety and adherence). • Discuss your recommendation(s) (pharmacologic and non-‐pharmacologic) in

detail. • Outline monitoring parameters to evaluate response to therapy, including

therapeutic endpoints, desired degree of change and who will monitor and for how long.

Conclusion This is a summary of the entire case presentation that focuses on the following

1 Adapted with permission from: 2011-‐2012 Structured Practical Experience Program, Leslie Dan Faculty of Pharmacy, University of Toronto. 2 AFPC -‐ Educational Outcomes for First Professional Degree Programs in Pharmacy in Canada. Communicator Section: 2010. 3 Cipolle RJ, Strand LM, Morley PC Pharmaceutical Care Practice: The Clinician’s Guide, McGraw Hill, 2004. 4 Adapted with Permission: Dr. ML Chavez, http://pharmacy.tamhsc.edu/departments/experiential/appe/forms/case-‐presentation-‐instructions-‐mc.pdf


55

& Critique questions: • How closely does the specific patient fit the "classic" case? What were the

similarities and differences? How closely did the specific patient fit with the patients studied in the literature?

• What was the patient’s response to therapy? • Did any adverse reactions occur in follow up? Could they have been avoided? • Do you agree with the therapy used? If not, what would you do differently and

why? • What medications were given at the time of discharge? Did you provide

medication counseling? Is adherence a potential problem? • What were the most important therapeutic principles you learned?

REFERENCES • Handout must include a reference list that includes current journal articles. In addition,

review articles, monographs, and textbooks can be used. • References must be cited correctly using Vancouver format. LEARNING PORTFOLIO Submit:

o A copy of the presentation handout given to the audience.


56


57

PATIENT CARE PRESENTATION EVALUATION FORM Date: __________________ Student:______________________________ Presentation Title: ___________________________________________________________________ Scoring: NI = Needs Improvement A = Acceptable Please support your scores with comments for NI

A. CONTENT

1. Assessment: Patient Description NI Clear omissions in data, incorrect data presented.

A Includes relevant medical and medication history and thoughtful description of the patient and patient’s situation, interactions with the patient. Few omissions in data, mostly relevant information presented.

Comments:

2. Care Plan: Identification of DRPs and Primary Issue NI Missed DRPs based on presented material, DRPs not relevant, patient concerns not considered, DRP’s

not prioritized.

A Identified the key issue or DRP, summary of DRPs clearly stated and prioritized, patient’s concerns integrated.

Comments:

3. Care Plan: Assessment Recommendations and Interventions NI Does not provide complete PC plan with goals, rationale and alternatives.

References not included, interventions not included.

A Gives rationale for recommendations for main issue or DRP (considering patient’s perspective, scientific evidence and ethical judgment), describes recommendations for other DRPs. Presents interventions (specifies student’s and preceptor’s role).

Comments:


58

4. Follow-‐up Evaluation NI Missing key monitoring parameters, no follow up discussed.

A Followed key monitoring parameters and timeframe for efficacy and toxicity. Presents outcomes and assessment of outcomes, seamless care performed, next steps identified.

Comments:

5. Reflections on Learning/Dialogue NI Lack of reflections on what was learned from the patient care experience, failed to pose question to

facilitate dialogue.

A Includes key learning points and invites dialogue with peers and preceptors drawing on the experiences of others.

Comments:

6. Therapeutics NI Inaccurate information presented, lacking information.

A Therapeutic knowledge current, comprehensive.

Comments:

7. Response to Questions NI Can not answer basic questions related to case

A Can provide additional information as needed in question period; may need some prompting, answers most questions and does not guess at answers. Able to discuss clinical reasoning and ethical considerations.

Comments:

Adapted with Permission: Pharmacy Services-‐Royal Alexandra Hospital, Edmonton, Alberta.

59 Phar489 Handbook

Copyright © 2012 UBC Faculty of Pharmaceutical Sciences

B. DELIVERY 1. Organization NI Presentation is disorganized, presents unnecessary information, presenter loses focus during

presentation.

A Consistently organized, flows logically, rarely includes unnecessary information.

Comments:

2. Communication – Verbal NI Hard to hear, mumbles, talks too fast, monotone voice, mispronounces words.

A No mumbling/ pronunciation errors. Volume and rate varied to enhance tone.

Comments:

3. Communication – Non Verbal NI Lack of eye contact, mostly reads off notes or computer screen, distracting mannerisms, lack of

interest.

A Consistently tries to make eye contact, occasionally reads notes. Usually appears confident. Gestures enhance presentation.

Comments:

4. Handouts/AV aids NI Difficult to read, poor color scheme, spelling mistakes, cluttered slides with too much text.

A Handout compliments the presentation, neat, organized with no errors.

Comments:

OVERALL ASSESSMENT: r NI r A

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61 Phar489 Handbook


GRADING SYSTEM The Pharmacy 489 Clerkship is Pass-‐Fail Grading. Learners must be successful in EACH of the required course components in order to be successful in the clerkship. The required course components include:

-‐ Practice Educator Evaluation: By the end of the rotation, learners must receive a minimum ‘satisfactory’ grade on ALL of the assessed AFPC Educational outcome competencies on the Practice Educator Evaluation of the Student form. The learner must also demonstrate acceptable professional behavior as outlined in the Faculty’s Professional Code of Conduct. The Practice Educator Evaluation of the Student must be completed in the E*Value system or using the paper-‐based form submitted in a sealed envelope or submitted in E*Value by the practice educator.

-‐ Learning Portfolio: Learners must ensure that all components of the Learning Portfolio are completed. The learning portfolio must be submitted in a professional and organized manner (3 ring binder with subject tab dividers) by the specified deadline for submission, which is FIVE days after the last rotation date at the site.

-‐ Care Plans: Learners must submit one patient work up that includes an allergy assessment (if applicable) and all care plans and follow up documentation. All care plans must follow the pharmaceutical thought process (NESA) and demonstrate competent care provided (see Requirements and Marking Scheme for Pharmacy Care Plans).

- Patient Care Presentation: The oral presentation must be completed in the context of applying evidence-‐based practice and improving patient care (PICO Model).

- Drug Information Request: Learners must ensure that they have submitted their best DIR for review following principles of PICO where applicable. The DIR requires in-‐depth research to determine the correct response requiring a pharmacotherapy workup (NESA). DIR must be provided in an organized, thorough, accurate and timely manner.

- Interprofessional Education: Evidence of collaboration completed in either PHAR 479 or PHAR 489, but submitted in the PHAR 489 learning portfolio.

- Connect Participation: Learners are expected to be familiar with all Connect course content and participate in discussion forums.

- Student Evaluations: Complete (1) Student Evaluation of the Program and Activities.

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63 Phar489 Handbook


LEARNING PORTFOLIO COVER PAGE

Legal First and Last Name

Student Number Email

Course Block(s) Dates of clerkship

Practice Educator(s)

Email(s)

Site name Address

Phone number

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65 Phar489 Handbook


SUMMARY OF LEARNING PORTFOLIO SUBMISSION

*Learners should carefully review this document, the course handbook, and Connect to ensure they meet all Learning Portfolio submission requirements. For in-‐depth descriptions of each activity, go to the corresponding section in the course Handbook. Activity Learner Trait (AFPC Outcome) Submission Requirements

1. Learning Contract COMMUNICATOR

SCHOLAR PROFESSIONAL

o *SUBMIT One (1) Learning Contract form for

PHAR 489

o *SUBMIT One (1) full patient workup: Include Assessment Form, all Care Plans, Follow-‐Up Evaluation Forms, Allergy Assessment, one care plan per medical condition. Make sure this is your BEST work and that you review the Requirements and Marking Scheme for Care Plans. Cannot be the same patient as your DIR or Patient Case Presentation.

2. Pharmaceutical Care

CARE PROVIDER COMMUNICATOR

ADVOCATE SCHOLAR

PROFESSIONAL

4. Patient Case Presentation

CARE PROVIDER COMMUNICATOR PROFESSIONAL

SCHOLAR

o *SUBMIT a copy of Power Point Slides and

Patient Case Presentation Evaluation From. Cannot be the same patient as Pharmaceutical Care or DIR.

3. Drug Information Request (DIR)

CARE PROVIDER COMMUNICATOR PROFESSIONAL

SCHOLAR

o *SUBMIT One (1) DIR. Make sure this is

your BEST work and that you review the Requirements and Marking Scheme for DIR. Cannot be the same patient as Pharmaceutical Care or Case Presentation.

66 Phar489 Handbook


Activity Learner Trait (AFPC Outcome) Submission Requirements

Further Instructions on Learning Portfolio Submission:

o Practice Educator to complete Practice Educator Evaluation of the Student on E*Value or form provided to the student in a sealed envelope for submission in learning portfolio.

o Complete Student Evaluation of Program and Activities on E*Value (instructions on Connect) o Practice Educator to complete Practice Educator Evaluation of Activities and Program form on E*Value or form

provided to the student in a sealed envelope for submission in learning portfolio. o Submit required Care Plan and DIR assignments through Turnitin software. Please refer to the OEE Course

Policies for more information about Turnitin. o If applicable, submit any other documentation as determined by the Program Director o If your practice educator or another pharmacist has made a difference to your learning please consider

nominating the individual for the Practice Educator of the Year Award (nomination form Available on Connect/from OEE)

o Please submit your Learning Portfolio in a 3-‐hole binder no wider than ½ inch.

Due Date

All portfolios must be received in the OEE office by 4PM FIVE days after the last day of the rotation, or be post-‐marked by FIVE days after the last day of the rotation. I.e.: If the last day of the rotation is June 1st, the portfolio must be received by the OEE before 4pm June 6th, or be post-‐marked June 6th. Any student who chooses to mail in their portfolio MUST use Canada Post Priority Service or an overnight courier that requires a signature receipt. Any portfolios received after the due date, or sent in by regular parcel mail will be considered incomplete. Portfolios will be not accepted after the 4PM due date. A late portfolio will result in automatic failure of the

rotation and will delay your graduation.

5. Inter-‐professional Education (IPE)

o See “IPE Clinical Placement Activity Series” on Connect for documentation requirements and *SUBMIT with portfolio.

COMMUNICATOR COLLABORATOR

ADVOCATE PROFESSIONAL

6. Service

CARE PROVIDER COMMUNICATOR

MANAGER SCHOLAR

PROFESSIONAL

Other activities as required by the Practice Site. Service activities should compromise no more than 30% of the rotation and may include the following: Medication Reconciliation, Nursing Inservices, Patient Mediation Profile Reviews, Discharge Counselling, ADR reporting, Drug Usage Evaluation, Formulary Requests, Chart Reviews. No submission required.

67 Phar489 Handbook


PRACTICE EDUCATOR EVALUATION OF THE STUDENT: PHAR489

Site

Date

Student Name

Practice Educator Name

Care Provider – Assess Patients Mid point

1 2 3 | 4 5 6 | 7 8 9 Unsatisfactory Satisfactory Superior

Comments

Final 1 2 3 | 4 5 6 | 7 8 9 Unsatisfactory Satisfactory Superior

Comments

Care Provider – Plan Care Mid point


Comments


Comments

Communicator – Written / Documentation Skills Mid point


Comments


Comments

Communicator – Verbal and Non Verbal Skills Mid point


Comments


Comments

68 Phar489 Handbook


Collaborator Mid point


Comments


Comments

Manager Mid point


Comments


Comments

Advocate Mid point


Comments


Comments

Scholar Mid point


Comments


Comments

Professional Mid point

Acceptable Unacceptable

Comments

Final Acceptable Unacceptable

Comments

69 Phar489 Handbook


Mid-‐Point Evaluation (Mid-‐point comments for each AFPC outcome to be completed by the Practice Educator and reviewed with the Student). It is the responsibility of the student to alert the Course Coordinator to any assigned “unsatisfactory” or “unacceptable” grade. The student must immediately fax the evaluation form to 604.822.3035 so that appropriate learner support can be provided. Action Plan (Student to complete an action plan to address areas requiring improvement for the remainder of the clerkship)

Practice Educator Signature ___________________ Date ____________________________ Student Signature __________________________ Date ____________________________ Final Evaluation (To be completed by the Practice Educator and signed by the Student) Both the student and practice educator must immediately notify OEE of any assigned “unsatisfactory” or “unacceptable” grade. Comments

Practice Educator Signature ____________________ Date ____________________________ Student Signature __________________________ Date ____________________________

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71 Phar489 Handbook


PRACTICE EDUCATOR EVALUATION OF THE PROGRAM AND ACTIVITIES: PHAR489

To be completed online in E*Value by the practice educator once per academic year.

Practice Educator’s Name (please print): Practice Site: Date: The information you provide will be used to review the Experiential Education Program. Your thoughtful ratings and constructive comments will be extremely valuable in making appropriate changes. Please indicate whether the activities could be fulfilled at the site: Activity

Were the activities able to be fulfilled at the site?

1. Provide Pharmaceutical care to patients o Yes o No

2. Participate in Interprofessional activities o Yes o No 3. Patient Care Presentation o Yes o No 4. Drug Information Requests o Yes o No 5. Service o Yes o No Please give your reaction to the following statements by selecting the response that best corresponds to your opinion: Program Agree Neutral Disagree Not

Applicable 1 The Learner Introduction form was a good icebreaker at the

start of the rotation in order to assure that mutual interests and needs could be met.

2 The Learning Contract was helpful to understand what the learner hoped to gain from the rotation.

3 The OEE provided the site with sufficient information on the required activities and learner to be placed.

4 I understood the Faculty’s expectations, goals and objectives for the rotation experience.

5 The Course Syllabi and required activities helped me guide the learner’s experience on the rotation.

6 The Evaluation Forms were easy to use.

7 I knew the Office of Experiential Education was available if I needed to discuss the learner’s clerkship or to clarify the activities.

8 I contacted the Office of Experiential Education and found the staff to be polite and courteous.

9 I met with or spoke to the Course Coordinator regarding the learner’s performance and was provided with appropriate guidance.

72 Phar489 Handbook


Program Agree Neutral Disagree Not Applicable

10 The Coordinator visited my site, and I found the site visit to be helpful in clarifying the rotation activities and expectations.

11 I found the OEE website useful. 12 Overall, I am satisfied with the direction of the Experiential

Program.

13 In general, this practicum experience helped the learner practice the problem solving process and clinical judgment.

14 In general, this practicum experience helped the learner understand the profession.

15 In general, this practicum experience provided the learner with an opportunity to practice the roles of an early pharmacist practitioner.

16 In general, this practicum experience helped the learner understand the major concepts and principles of pharmacy.

Have you participated as a preceptor for The University of British Columbia Faculty of Pharmaceutical Sciences before? YES � NO � Have you completed preceptor training? (If YES, please provide specific program name and date of completion) YES, Program Name: ________________________ � NO Date Completed: ________________________ Would you like the Coordinator to do a site visit? YES � NO As a current pharmacy practice educator you are eligible to apply for a Campus Wide Login (CWL) account and UBC Card, which offers you access to the online UBC Library Database, and other UBC discounts. � If you would like to apply for a UBC Card, Please provide us with your EMAIL so we can forward to you the appropriate administrative forms to get the process started. **Please note processing may take up to 4-‐6 weeks to complete. Thank you for your patience. ** EMAIL: _________________________ Please indicate any other specific comments and suggestions which you feel will be helpful to the Experiential Education Program. Completed forms can also be submitted along with the “Practice Educator’s Evaluation of the Student” in a sealed envelope.

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